Grappling with my chronic lower back painLaurien Zurhake
In February 2017 during the Munich Open in Germany I entered the competition with lower back pain. Many people in my gym suffer from lower back pain too, so I did not pay much attention to it in the beginning. That was over six months ago and the complaints steadily increased. During the fight I realized something was really wrong and visited my doctor soon after. After a MRI scan it became clear: I had a herniated disc.
Having a herniated disc meant that I had to refrain from training for about three months, go twice a week to a physiotherapist, do a lot of yoga and other lower back strengthening exercises. The three boring months slowly passed away but the pain subsided. I remember the very first day when I stood up and bent forward to pick something up without feeling any pain. I had totally forgotten what that felt like.
After this period it was finally time to step on the mats again and slowly regain my training rhythm. However, that was easier said than done: even though the initial injury had healed, my body was not convinced yet that it was. You may wonder what the result of this mistrust was? My lower back muscles cramped up like crazy and I could literary not walk for two days. I had to crawl on all fours to go to the bathroom. These are typical occurrences from people recovering from chronic pain. As you can imagine, my frustration was beyond measuring: again I could not train for some time. Not to mention the hard realization that I was in this state an absolute shitty training partner, because I could apply some things on them but they not on me – accepting that was tough.
What is Chronic Pain?
Chronic pain is, like pain itself, a poorly understood phenomenon. It has proved itself to be a worthy advocate for, in my view, breaching the walls of the dominant and outdated Western Cartesian Medical systems, because it challenged that paradigm. The Cartesian Duality represents two modes of thought regarding human beings that highly influenced Western Medical practice: homo duplex and homo clausus. The first alludes to the separation between body and mind and the second to the human being as a machine that cannot be affected or impacted by social and cultural elements. Simply put, this means that every medical condition must be somehow physically visible und explained in biophysical terms. However, therein lies a dilemma: what if a patient continuously complains about pain, shows clear signs of being in pain but there is nothing detectable?
As with all paradigms, it first wants to ignore anomalies such as invisible long-during pains, but cannot uphold its current status when the anomalies keep on coming. The result is a paradigm shift in which a new paradigm is formulated. The new and current one takes socio-cultural and psychological aspects into account as possible (additional) causes for chronic pain.
Let us focus briefly on the current chronic pain definition as formulated by the International Association for the Study of Pain (IASP). Chronic pain is understood as pain that persists beyond the normal time of healing.1 The average healing time for an injury is between three to six months.
This brings us back to my story for a moment: as I mentioned above I also had longer than six months my back problems. Surely, as became clear through the scans, my injury was not healed yet at that time. However, my chronic pain issues started actually after it my disc was healed. How is this possible?
The Brain and Pain
After doctors found out that there are also many asymptomatic people with herniated discs, i.e. people with the same condition I have but then without pain, the diagnostic importance of specific scanning methods for finding chronic pain causes became less. Recent studies suggest that up to 80% of people reaching the age of 80 will have herniated discs, as it is a normal aging feat.2 However valuable scans may be for other injuries, when it comes to the interplay between herniated discs and chronic pain, scans do not seem to be the answer.
Neuroscience, however, searches the cause for chronic pain in the brain. It suggests that a persons’ sensitivity to experiencing pain increases while at the same time their capacity of assessing that pain reduces. Normally, when something happens, for instance, you hit your knee at a sharp corner of a table, nociceptors, which are sensors in the body, decide whether the body is in danger and whether you should feel, as a result, pain. In the case of people who suffer chronic pain these nociceptors are incapable of determining whether the body is at risk. Yet, these sensors still send information to the brain. In neuroscience this is called the ‘gating mechanism’ in the dorsal horns of the spinal cord and enables pain perceptions to be altered. Quoting neurologist Lorimer Mosely, “pain depends on the perceived stimulation level, not the actual stimulation level.”3 In other words, when the brain somehow thinks that a specific body part is still injured, or newly injured, even if it is just an inconsequential scratch, pain occurs. Therefore, “[chronic] pain is 100% real, but it no longer accurately signals damage.”4 I would like to stress here that neuroscience does not claim that people “imagine” their pains. What they feel is real, it just does not mirror the present state of their body.
Yet, why would the brain think in such a way? Neuroscience would answer that it is all about meaning. It is here where social and cultural aspects, often under the guidance of medical anthropologists, make their appearance on the medical stage. Anthropologists claim that a person learns in a specific culture how he/she is ought to experience, deal with, and express phenomena such as pain.5 As a result, certain cultural ideas about the body and pain influences how one gives meaning to his or her pain. All these socio-cultural elements impact how the brain responds to pain sensations.
That said, it brings us to the last important question: how can we get rid of chronic pain? According to neuroscience by retraining the brain. This is not an easy feat when one considers how deeply rooted socio-cultural ideas are in a human being. It is, therefore, a slow and challenging process but a process that will teach your nociceptors to function properly once again thereby relieving you from your pain in due time.
Having read several stories from people who suffered diverse chronic pain conditions, it mostly took them a year to convince their body that all is fine. My goals are set: I want to compete again this October in Berlin. I do not know how often my lower back muscles will cramp up, but I do know, no matter how long it will take, that nothing will keep me from entering the mats!
Butler, D and Lorimer Mosely, Explain Pain (2003).
Crawford, Rebecca J. Volken (et al.), ‘Rate of lumbar paravertebral muscle fat infiltration versus spinal degeneration in asymptomatic populations: an age-aggregrated cross-sectional simulation study, in: Scoliosis and Spinal Disorders. vol. 11 (2017) 1-21.
Driessen, Henk, Cultuur en Pijn (2004).
Kim, SJ, TH. Lee (et al.), ‘Prevalence of disc in asymptomatic korean subjects. Part 1: lumbar spine’, in: Korean Neurosurg Soc. vol. 53 (2013) 31-38.
Mosely, Lorimer, ‘Body in Mind – the role of the Brain in Chronic Pain’, online seminar at Mind & Its Potential 2011: https://www.youtube.com/watch?v=RYoGXv22G3k&t=13s
Okada, Eijiro, Matsumoto, Morio (et al.), ‘Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: Comparison study with asymptomatic volunteers’, in: European Spine Journal. vol. 20, issue 4 (2011) 585-591.
5 Henk Driessen, Cultuur en Pijn (2004) 4.